Justice News

10 Year Sentence For Doctor Who Defrauded AFLAC

SAN JUAN, P.R. – On Monday, March 21, 2016, the Hon. Gustavo Gelpí sentenced Aníbal Pagan-Romero, a general practitioner with a clinic in Quebradillas, Puerto Rico, to a term of imprisonment of 120 months and a term of supervised release of five (5) years in the criminal case for mail fraud prosecuted against Pagan-Romero in federal court. Pagan-Romero was also ordered to pay $2,056,503.32 in restitution to the American Life Assurance Company (“AFLAC”) of Columbus, Georgia. This sentence is the result of a lengthy investigation undertaken by the Federal Bureau of Investigations into multiple insurance fraud schemes in the Western region of Puerto Rico which resulted in the arrest and prosecution of hundreds of individuals.

On October 5, 2015, Aníbal Pagan-Romero had been found guilty by a jury of his peers on all counts of an 82 count indictment charging 21 conspiracies and 61 individual counts of mail fraud. Pagan-Romero was charged with 35 patients for orchestrating a large-scale fraudulent scheme where he fraudulently signed AFLAC accidental insurance claim forms without examining the patients. The evidence presented at trial showed that Pagan-Romero caused a loss to AFLAC in excess of $6,000,000. The 35 patients who were charged alongside Pagan-Romero pled guilty to the charges prior to the trial.

The three-week trial before the Hon. Gustavo Gelpi included the testimony of three of the doctor’s employees and four patients who indicated that Pagan-Romero personally instructed them to submit the documents for his signature without examination. The evidence also showed that the scheme had grown so large and lucrative that Pagan-Romero had to hire two employees to do data entry full time in order to generate the thousands of AFLAC claim forms submitted for reimbursement under his signature.

The case was prosecuted by Assistant United States Attorneys Dennise N. Longo and Julia Díaz-Rex.